Financial, Human, and Physical Resource Limitations Challenge Health Systems

similar pattern, albeit with greater heterogeneity within the region. The WHO set a minimum threshold of 45 skilled health workers per 10,000 population to deliver system objectives (WHO 2016). In the GCC, only Bahrain failed to meet this target (33.8) in 2014, while only Libya, Lebanon, and Jordan in developing MENA met this target (see Figure 5.3). These data speak only of quantities, although the recent literature and practice pay increasing attention to the quality of service delivery such as competence of the health workforce.15 Such data are missing for all countries in the region.

Supplies—including essential medicines, personal protective equipment, diagnostics, or advanced health technologies— are critical for effective service delivery. Yet, there is a lack of reliable public data on their availability. For example, there is varying data availability for essential medicine supply in GCC countries (those with public data report adequate supply), while developing MENA has greater heterogeneity and lower availability of essential medicines (WHO Eastern Mediterranean Regional Office 2019). Like other health system inputs, such as physical capital or human resources, adequate functional and reserve capacity are predicated on intact and efficient supply chains.

Overall, there is a stark divide between GCC and middle-income MENA countries in health system resources. The GCC is converging with other high-income countries. The GCC countries significantly prepay, or share the risk of, health care costs, mostly from public sources. But their total per capita health spending is lower than in other high-income countries, even though health spending accounts for a greater share of government expenditures than that of their peers. At the same time, developing MENA economies rely heavily on OOPS for health services, with few funds available to pay for core system functions (especially for public health), or to develop reserve capacities.

Financial, Human, and Physical Resource Limitations Challenge Health Systems

The region’s healthcare resource limitations pose challenges to the coordination and provision of public health functions, financial risk protection, and delivery of first-level preventive and therapeutic health services. For example, despite the overdependence on hospitals, the number of hospital beds per 1,000 people (hospital bed density) in the region lags that of peers. In the GCC, hospital beds cluster around 2 per 1,000 people, and while it varies more in developing MENA, bed density is similar. In the OECD, hospital bed density is about 3.6. Inefficient distribution of hospital beds— particularly intensive care beds—further exacerbates inflexible functional capacity and limits reserve capacity. The WHO Eastern Mediterranean Regional Office (EMRO) also reports that primary health care (PHC) facility density per 10,000 population for all MENA countries is low (see Figure 5.4). There is wide variability within the region, but the overall low densities reflect the vulnerability of a region that relies on hospitals to provide basic care. Additionally, MENA has been slow to adopt digital health technologies to increase flexibility in delivering health service access and quality.

Publicly available service coverage and quality data are also limited. Key primary health care indicators—such as prenatal care, outpatient visits per capita, or select immunizations—are reported publicly, although data and/or service quality are less certain. Coverage data vary and provide proxy measures for first-level service delivery performance, but do not indicate the ability of these services to adapt to new or surging demands, according to latest data from Global Health Observatory data. These indicators are best summarized by the WHO’s Universal Health Coverage service coverage index, which captures the geometric mean of 14 indicators that trace essential health service coverage. MENA countries underperform compared to income peers. The index ranges from 68 to 77 of a possible 100 in the GCC (compared with

15 Gatti et al., 2021.